Conjoined twins: an obstetrician’s guide to prenatal care and delivery management (2024)

Table of Contents
Subjects Abstract Objective Study design Results Conclusion Access options Additional access options: Similar content being viewed by others Chorionicity and neurodevelopmental outcomes in twin pregnancy: a systematic review and meta-analysis The effect of placental location identified before delivery on birthweight discordance among diamniotic-dichorionic twin pregnancies: a three-year retrospective cohort study Multidisciplinary team approach to the prenatal management of orofacial clefts: a single center cohort study in Taiwan Data availability References Author information Authors and Affiliations Contributions Corresponding author Ethics declarations Conflict of interest Ethics approval and consent to participate Additional information Supplementary information Supplementary Information Legend Supplementary Table 1. Sites of fusion Supplementary Figure 1. Second trimester anatomic survey of conjoined thoracopagus twins, Case 2 Supplementary Figure 2. Intra-operative marking of uterus in preparation for delivery in Case 2 Supplementary Figure 3. Example OR layout for delivery of conjoined twins 41372_2021_1107_MOESM6_ESM.tif Supplementary Figure 5. Immediately following delivery of conjoined twins in Case 2 Supplementary Figure 6. 3D postnatal modeling for surgical planning in twins from Case 2 Rights and permissions About this article Cite this article
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Subjects

Abstract

Objective

Obstetricians infrequently encounter conjoined twins. Much of the clinical care literature focuses on postnatal management from a neonatology and pediatric surgery perspective; guidance on obstetrical management is limited. We outline steps for prenatal evaluation, obstetrical care, and delivery planning.

Study design

Experiences with two cases of conjoined twins.

Results

We identified several points throughout the planning, delivery, and postnatal process that are important to highlight for optimizing clinical outcome, patient safety, and parental satisfaction.

Conclusion

After diagnosis, patients should be referred to a center experienced in the management of conjoined twins. Specialists in fields including maternal fetal medicine, pediatric surgery, neonatology, and radiology play a vital role in the management of these patients. Early referral allows for timely family counseling and decision-making. Prenatal evaluation beyond the first trimester should include a detailed ultrasound, fetal echocardiogram, and fetal MRI. 3D printed life-sized models can improve delivery planning and patient understanding.

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Conjoined twins: an obstetrician’s guide to prenatal care and delivery management (1)
Conjoined twins: an obstetrician’s guide to prenatal care and delivery management (2)

Similar content being viewed by others

Conjoined twins: an obstetrician’s guide to prenatal care and delivery management (3)

Chorionicity and neurodevelopmental outcomes in twin pregnancy: a systematic review and meta-analysis

Article 04 November 2022

Conjoined twins: an obstetrician’s guide to prenatal care and delivery management (4)

The effect of placental location identified before delivery on birthweight discordance among diamniotic-dichorionic twin pregnancies: a three-year retrospective cohort study

Article Open access 20 August 2019

Data availability

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

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Author information

Author notes

  1. D’Angela Pitts

    Present address: Henry Ford Health System, Detroit, MI, USA

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA

    Patricia S. Greco,D’Angela Pitts,Marjorie C. Treadwell&Alissa Carver

  2. Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA

    William J. Weadock,Maria Ladino-Torres&Naomi T. Laventhal

  3. Department of Radiology, University of Michigan, Ann Arbor, MI, USA

    William J. Weadock&Maria Ladino-Torres

  4. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Naomi T. Laventhal&George Mychaliska

Authors

  1. Patricia S. Greco

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  2. D’Angela Pitts

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  3. William J. Weadock

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  4. Maria Ladino-Torres

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  5. Naomi T. Laventhal

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  6. George Mychaliska

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  7. Marjorie C. Treadwell

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  8. Alissa Carver

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Contributions

PG formulated the concept of the paper, wrote the entire manuscript, researched prior publications, and corresponded with the co-authors on their input. DP provided input on the manuscript. WW and ML created the images and models used in the described cases and provided input on the manuscript. NL provided input on the manuscript. GM provided input on the manuscript. AC helped with formulation of the concept behind the paper, researched prior publications and provided input on the manuscript. MT helped with formulation of the concept behind the paper, researched prior publications and provided input on the manuscript. All authors approved the final submitted version of the manuscript and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Patricia S. Greco.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethics approval and consent to participate

This study was performed in accordance with the Declaration of Helsinki. Both patients signed consent to participate in this review.

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Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Conjoined twins: an obstetrician’s guide to prenatal care and delivery management (6)

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Greco, P.S., Pitts, D., Weadock, W.J. et al. Conjoined twins: an obstetrician’s guide to prenatal care and delivery management. J Perinatol 41, 2424–2431 (2021). https://doi.org/10.1038/s41372-021-01107-5

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  • DOI: https://doi.org/10.1038/s41372-021-01107-5

Conjoined twins: an obstetrician’s guide to prenatal care and delivery management (2024)
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